Aspirin Desensitization Reduces Alcohol-Related Respiratory Symptoms

John V. Bosso, MD

Patients who undergo aspirin desensitization therapy to combat Aspirin Exacerbated Respiratory Disease (AERD), are likely to find that the treatment also alleviates their alcohol-induced respiratory symptoms.

Those are the results of a new study that looked at how aspirin desensitization, a common AERD therapy, impacts alcohol allergies. About three quarters of patients with AERD also experience respiratory symptoms when they consume alcohol.

Patients with AERD suffer nasal polyps, sinusitis, and asthma when exposed to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS). A common treatment for the condition is to give patients small doses of aspirin and then steadily increase the amount as their tolerance for aspirin increases. This process usually follows endoscopic sinus surgery to remove nasal polyps. The combination treatment allows patients to then use aspirin to limit any future inflammatory polyp growth.

The question in the study was whether that treatment also impacts alcohol allergies, an important question given the high percentage of people who suffer from both conditions. To study the issue, researchers enrolled 45 patients who suffered from AERD and alcohol-induced respiratory symptoms. Thirty-seven of those patients completed the study.

Patients were surveyed before and after surgery and aspirin desensitization to gauge the extent to which alcohol consumption brought respiratory symptoms.

Prior to the treatments, three-quarters (78%) of participants said they could tolerate alcohol half of the time or less, and 42% said they could never or almost never tolerate it. After the therapy, 86.5% said their ability to tolerate alcohol had improved, and 70% described the intervention as either “very helpful” or “extremely helpful” to their alcohol tolerance.

The University of Pennsylvania’s John V. Bosso, MD, director of Penn Medicine’s Otorhinolaryngology Allergy Clinic and medical director of the Penn AERD Center, told MD Magazine® the treatment backgrounds of the patients in the study make clear that it is the aspirin desensitization that results in the positive changes related to alcohol consumption.

“All of these patients have had multiple surgeries in the past without aspirin desensitization and their alcohol intolerance did not improve from surgery alone; therefore, it is extremely likely that this is the aspirin desensitization which is resulting in the positive changes,” he said. “Surgery would also not be expected to change the release of inflammatory mediators from cells like basophils and mast cells like aspirin desensitization has been shown to do.”

It is the release of those basophils and mast cells that triggers the respiratory symptoms in people with alcohol allergies, he noted.

The good news for patients, particularly those who have already undergone multiple surgeries, is that alcohol sensitization seems to have a long-lasting, or perhaps permanent, impact.

“In our long-term study of patients undergoing coordinated complete sinus surgery followed by aspirin desensitization, approximately 90% of patients had either excellent or good responses and saw a dramatic reduction in symptoms and our Penn AERD Center re-operation rates were less than 10%,” he said.

The study, “Alcohol‐induced respiratory symptoms improve after aspirin desensitization in patients with aspirin‐exacerbated respiratory disease,” was published July 10 in the International Forum of Allergy and Rhinology.